Provider Demographics
NPI:1740646967
Name:TRINA HEALTH OF BOONEVILLE, INC
Entity type:Organization
Organization Name:TRINA HEALTH OF BOONEVILLE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:662-554-2955
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-0250
Mailing Address - Country:US
Mailing Address - Phone:662-554-2955
Mailing Address - Fax:662-728-3181
Practice Address - Street 1:202 N 1ST ST
Practice Address - Street 2:SUITE B
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-2718
Practice Address - Country:US
Practice Address - Phone:662-554-2955
Practice Address - Fax:662-728-3181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy